1. Chapter 25
The Elderly

2. Most Common Mental Health Problems in Elderly
Anxiety
Severe cognitive impairment
Delirium
Depression
Dementia
Suicide rate for people age 85 and older is twice overall national rate

3. Delirium Acute change in level of consciousness and cognition
Usually develops over short period of time
Visual hallucinations common
Damage to brain can become permanent
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4. Delirium Possible causes: Infections Dehydration
Adverse drug reactions
Electrolyte imbalances
Hypoglycemia
Hypoxia

5. Depression May be symptom of physical disorder
Drugs may cause depression
Nutritional deficiencies and alcohol may cause depressive symptoms

6. Symptoms Symptoms may be cognitive, social, physical, or emotional
E.g., paranoia, pessimism, sadness, self-degradation, difficulty concentrating or thinking, disturbances of appetite and sleep
Early treatment important

7. Subtypes of Depression
Major clinical depression
Dysthymic disorder
Adjustment disorder
Grief and depression

8. Assessment Screening tools Onset and pattern of symptoms
Listen closely
Family history
Suicidal ideation

9. Nursing Diagnosis
Hopelessness
Self-esteem
Situational low
Chronic low

10. Planning/Interventions
Choose drug therapy carefully
Consider safety issues
Identify pleasurable activities
Consider environmental influences

11. Dementia Impairment of memory with at least one of the following:
Aphasia
Apraxia
Agnosia
Disturbance in executive functioning

12. Alzheimer’s Disease Number one mental health problem among elderly
Progressive impairments and dependency
Average duration of illness:
Eight years
Estimated that 14 million will have disease in next 50 years

13. Diagnosis and Etiology
Cause unknown
Plaques and neurofibrillary tangle in brain
Some cases may be genetic
Some cases may be due to environment
Diagnosis made by neuroimaging

14. Treatment Cholinesterase inhibitors Slows down progression of disease
E.g., donepezil hydrochloride (Aricept)
Slows down progression of disease
Vitamin E, nonsteroidal anti-inflammatory drugs (NSAIDs), or estrogen may help

15. Vascular Dementias Multi-infarct dementia
10 to 20 percent of all dementias
Result of multiple small strokes
Diagnosed by CT, MRI, or history

16. Other Dementias Alcoholic dementia Creutzfeldt-Jakob disease
Korsakoff’s syndrome
Creutzfeldt-Jakob disease
Acquired immunodeficiency syndrome (AIDS)
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17. Other Dementias
Lyme disease
Parkinson’s disease
Huntington’s disease

18. Symptoms and Sequelae Memory loss Confabulation Aphasia
Delayed response time
Paranoia
Alterations in perception
Wandering
Disinhibition
Catastrophic reactions

19. Assessment Dementia Rule out reversible cause
Diagnosis of exclusion
Rule out reversible cause
May use screening instrument

20. Nursing Diagnosis
Reflect physical and emotional stresses of caring for every physical need
Coping with difficult behavioral responses
Coping with safety risk imposed by person who may wander
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21. Nursing Diagnosis Extended period of time for caregiving
Including financial, legal, and ethical issues
Emotional adjustments to role changes

22. Caring for Caregivers Honesty with diagnosis Relationship tensions
Financial and legal affairs
Use of community resources
Guilt over nursing home placement
Humor
Positive aspects